Purpose

To evaluate whether pulmonary arterial hypertension (PAH) is associated with an increased risk of incident acquired ptosis compared to a propensity-matched chronic cardiopulmonary disease control population.

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Methods

A retrospective cohort study was performed using the TriNetX US Collaborative Network. Cohort 1 comprised adults with PAH (ICD-10: I27.0/I27.2), excluding WHO Group 2 (left heart disease) and Group 3 (lung disease/hypoxia) etiologies, and without pre-existing COPD. Cohort 2 comprised adults with COPD without PAH. Both cohorts excluded patients with congenital ptosis, Horner syndrome, myasthenia gravis, eyelid neoplasms, or trauma. Propensity score matching (PSM) on age, sex, race, comorbidities, medications, and BMI yielded 841,805 patients per cohort. Outcomes included incident ptosis (H02.40-43), ptosis repair surgery (CPT 67901-67908), and paralytic ptosis. Kaplan-Meier survival analysis with log-rank testing and Cox proportional hazards modeling were performed.

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Results

After PSM, PAH patients demonstrated a significantly higher hazard of incident ptosis compared to COPD controls (HR 1.112, 95% CI 1.067-1.160; log-rank p<0.001). There was no significant difference observed in ptosis repair surgery (HR 1.072, p=0.226) or paralytic ptosis (HR 0.738, p=0.868).

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Conclusion

PAH is independently associated with a significantly increased risk of incident acquired ptosis following PSM in a large national cohort. The absence of increased paralytic ptosis and surgical rates suggests a non-neurogenic, possibly myogenic or vascular mechanism. These findings highlight the importance of ophthalmological surveillance in PAH patients and warrant further investigation into underlying pathophysiological mechanisms.

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Additional Authors

First name	Last name	Base Hospital / Institution
Yasaman	Ataei	Scheie Eye Institute, University of Pennsylvania
William	Katowitz	Scheie Eye Institute, University of Pennsylvania

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